Vascular Stiffness as an Target of Optimal Antihypertensive Therapy

Abstract

Objective:To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine / indapamide / perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN).Design and method:The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine / indapamide / perindopril. The patient’s condition was assessed during 4 observation visits: visit 1- inclusion, visit 2 - 4 weeks, visit 3 -12 weeks, visit 4 - 24 weeks observation. At each visit, the achievement of the target BP level < 130/80 mm Hg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI)) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPMResults:In subjects with HTN with ineffective antihypertensive therapythe initial office BP was 160.8 ± 10.3 / 91.5 ± 8.1 mm Hg. After 24 weeks of therapy with a TFC there was a significant decrease in blood pressure to 121.3 ± 3.5 / 73.6 ± 4.2 mm Hg (p < 0.001). According to ABPM data, mean values of daily BP significantly (p < 0.001) decreased from 153.9 ± 9.04 / 8.38 ± 9.18 to 120.3 ± 4.7 / 73.4 ± 4.7 mm Hg. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p < 0,05) as well as ASI (174 (138, 253) vs 139 (107.196) mmHg; p < 0.001) and Aix -29,9 (-41,12) vs - 33,7 (-53, 9) p < 0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta (Fig.1)Conclusions:In patients with HTN and previous uneffective antihypertensive therapy the FTC amlodipine / indapamide / perindopril provided high antihypertensive effectiveness. Parameters of vascular stiffness can serve as criteria for quality control of blood pressure and can be used to assess the effectiveness of antihypertensive therapy.